The Institute of Medicine is the health arm of the National Academy of Sciences. On April 23, 2010, it released a report, “Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making.”

New Framework Recommended for Decision Making and Research on Obesity Prevention

April 23, 2010 — To battle the obesity epidemic in America, health care professionals and policymakers need relevant, useful data on the effectiveness of obesity prevention policies and programs. A new report from the Institute of Medicine identifies a new approach to decision making and research that uses a systems perspective to gain a broader understanding of the context of obesity and the many factors that influence it.

Is the IOM systems approach missing what could be a large component of the system?

The Institute of Medicine states that it is adopting a systems approach to obesity prevention. That sounds pretty comprehensive, right?

Well, maybe not. Cutting to the chase, this report appears to be limited to looking at obesity prevention interventions and not all obesity causes. The focus is entirely on caloric and energy balance. But what if, as Dr. Robert Lustig and others have argued, what you eat and how it is metabolized are factors in the obesity epidemic? Energy intake and energy expenditure might not reveal the whole picture.

That idea does not appear to have crossed their minds. The framework and approach that are recommended look like they have merit, but I would argue that the authors are not looking at as large a system as they should be.

The environmental factors they do mention are along the lines of the “activity environment” and the food environment.”

Links to Report Information

There are links to several different items here. The links above are to a news release and the Institute of Medicine (IOM) Report web page (i.e. the page for the project/activity). Links below are to the full text of the report online, the report recommendations, a four page report brief, as well as links to a webcast and podcast of the briefing on the release of the report, links to related resources (which duplicate some of the other links), and links to pages on the meetings that led to the creation of the report.

To battle the obesity epidemic in America, health care professionals and policymakers need relevant, useful data on the effectiveness of obesity prevention policies and programs. A new report from the Institute of Medicine identifies a new approach to decision making and research that uses a systems perspective to gain a broader understanding of the context of obesity and the many factors that influence it.

The above post concerns a hearing held to hear about a report from the Government Accountability Office (GAO) on EPA’s progress in protecting children from environmental threats. It discusses the challenges EPA faces in protecting children’s health. (To be fair, many people acknowledge that shortcomings in the Toxic Substances Control Act, or TSCA, are responsible for EPA’s being unable to protect children and others from environmental pollutants.)

I’m not usually one to plug particular networks, but I thought the following mentioned in the Dr. Gupta blog might be of interest.

EPA Has Not Focused Attention on Children’s Health in Agencywide Priorities, Strategies, and Rulemakings

Includes a figure showing the steps where children are considered in the EPA rulemaking progress. The report does note that some offices within EPA more consistently incorporate considerations for children’s health in their work than others, but notes that at least one other federal agency does not even seem to do that.

In Recent Years, EPA Has Not Fully Utilized Its Office of Children’s Health and Other Child-Focused Resources

Opportunities Exist for EPA to Lead and Coordinate National Efforts to Protect Children from Environmental Threats

“…While EPA leadership is key to national efforts to protect children from environmental threats, EPA’s efforts have been hampered by the expiration in 2005 of certain provisions in the executive order. For example, the Task Force on Children’s Environmental Health provided EPA with a forum for interagency leadership on important federal efforts, such as the National Children’s Study.”

GAO recommended that Congress consider the following:

Because EPA alone cannot address the complexities of the nation’s challenges in addressing environmental health risks for children, Congress may wish to consider re-establishing a government-wide task force on children’s environmental health risks, similar to the one previously established by Executive Order 13045….

Chairman Barbara Boxer will convene the Full Committee for a hearing on the Government Accountability Office’s (GAO) investigation of the Environmental Protection Agency’s (EPA) children’s health program. The committee will also examine what can be done to strengthen protections for children.

Senator Bill Nelson (D-FL) is also expected to give testimony on the federal government’s role in investigating children’s health issues and how that can be improved.

EPA’s response

EPA agrees that the GAO report reflects well the early history and progress of the Agency’s children’s health protection efforts. The report accurately portrays the Agency’s challenges in addressing children’s environmental health, and sets forth sound recommendations on steps that could be taken to better incorporate protection of children’s health as an integral part of EPA’s everyday business.

Grevatt also noted that EPA Administrator Lisa Jackson had designated the protection of children’s health as one of her top priorities. He then described how EPA would implement its strategy to protect children’s health.

EPA will use the best science to ensure that regulations provide for protection of children’s environmental health by actively addressing the potential for unique childhood vulnerability and exposure. Our goal is to reduce negative environmental health impacts on children through rulemaking, policy, enforcement and research that focus on prenatal and childhood vulnerabilities.

Protecting children through safe chemicals management.

Coordinate national and international community based programs to eliminate threats to children’s health while measuring and communicating our progress.

Most of the well-financed breast cancer organizations make little or no mention of the non-genetic causes of breast cancer. Go to their websites. Read their literature. These organizations don’t focus on the environmental and pharmacological causes of this epidemic because it’s a dank dark alley that leads right to their corporate sponsors.

Landes cites the Green Guide, a publication of the Green Guide Institute: “National Breast Cancer Awareness Month was established by Zeneca, a bioscience company….” Zeneca had “sales of $8.62 billion in 1997. Forty-nine percent of Zeneca’s 1997 profits came from pesticides and other industrial chemicals, and 49 percent were from pharmaceutical sales, one-third (about $1.4 billion’s worth) of which were cancer treatment drugs.”

Landes also notes that General Electric, Rhone-Poulec, Rohm & Hass, Eli Lilly Novartis, American Cyanamid, and Dupont have all profited from both sides of the breast cancer epidemic. She further notes that NIH and CDC have tended to side with corporate conglomerates by focusing more on the detection and cure side of the equation than on the identification and elimination of environmental causes.

Dr. Tyrone Hayes at the University of California at Berkeley has spent his career examining atrazine and its effect on the growth and development of frogs. He has shown that atrazine chemically castrates and feminizes male amphibians in the wild and in the lab. He suggests that atrazine-induced deformities result from the depletion of androgens and production of estrogens, perhaps after atrazine increases the activity of aromatase.

When Dr. Hayes presents his research, he often tells this story: The maker of atrazine is Syngenta, a multi-national agrichemical corporation. Syngenta was formed in 2000, when another multi-national called Novartis merged their Crop Protection and Seeds businesses with Astra Zeneca’s Agrochemicals. What is interesting and very disturbing, he argues, is that Novartis is also the producer of Femara, the breast cancer drug discussed above. And so, Dr. Hayes points out, the very company that produces atrazine (that “turns on” aromatase, thereby increasing estrogen which can lead to breast cancer cell growth) is also producing — and selling at great profit — a medication that has the opposite effect (to “turn off” aromatase).

Helen Cordes discusses how the major breast cancer awareness programs avoid discussing environmental causes (as well as the impact of mammograms and mammography advice on breast cancer).

Critics such as veteran women’s health advocate and writer Barbara Ehrenreich note that AstraZeneca, long a leader in the global multi-billion-dollar breast cancer pharmaceuticals market, founded National Breast Cancer Prevention Month–the generator of Pink October frenzy–in 1985, when then-Zeneca was also in the business of making pesticides deemed “probable human carcinogens” by the EPA. NBCAM is still controlled by AstraZeneca and its single-minded ‘get-your-mammogram’ mantra echoed by cosponsoring radiological and oncology associations and cancer establishment organizations. Other breast cancer heavy-hitters such as the American Cancer Society and the Susan G. Komen Foundation are also too influenced by corporate backers, say critics such as Pink Ribbons Inc. author Samantha King and No Family History author Sabrina McCormick. The result (seen most clearly in NBCAM materials) is that breast cancer’s environmental causes are avoided or downplayed to focus instead on directives to get mammograms, stay fit, and when diagnosed, obey conventional treatment regimens. (emphasis added)

While personal actions are important, why not actually prevent cancer from developing in the first place by reducing exposure to carcinogens? For example, benzene is defined by the National Toxicology Program as a known human carcinogen, and yet the NTP profile on benzene (see the profile for references) notes:

Benzene is used as an additive in gasoline, but it also is present naturally in gasoline, because it occurs naturally in crude oil and is a by-product of oil-refining processes. The percentage of benzene in unleaded gasoline is approximately 1% to 2% by volume.

In 2002, U.S. imports of benzene totaled over 4 billion liters (1.1
billion gallons), which greatly exceeded exports of 6 million liters (1.6 million gallons). This trend continued in 2003, during which 4.5 billion liters (1.2 billion gallons) were imported and 110 million liters (29 million gallons) were exported.

The U.S. Environmental Protection Agency’s Toxics Release Inventory listed 1,008 industrial facilities that released benzene into the environment in 2001. Reported benzene releases decreased from 34 million pounds (15,400 metric tons) in 1988 to 6 million pounds (2,700 metric tons) in 2001. In 2001, reported emissions to the air totaled 5 million pounds (2,300 metric tons), and reported discharges to surface water totaled 19,000 lb (8.6 metric tons).

Title: A bill to amend the Public Health Service Act to authorize the National Institute of Environmental Health Sciences to conduct a research program on endocrine disruption, to prevent and reduce the production of, and exposure to, chemicals that can undermine the development of children before they are born and cause lifelong impairment to their health and function, and for other purposes.

Both versions of the bill were introduced on Dec. 3, 2009, and were referred to committees in their respective chambers.